Does Medicare Cover TMS?

If you’re 65 years or older and suffer from depression, you may have wondered, “Does Medicare cover TMS?” Medicare does in fact cover transcranial magnetic stimulation (TMS) treatments. When treated by licensed, Medicare-approved physicians such as Dr. Bryan Bruno, the Medical Director at Mid City TMS, who are proficient in the administration of TMS, a patient with Medicare is eligible to receive full coverage for the procedures.

Depression is one of the most common and serious mental illnesses in the United States. In 2017, the National Institute of Mental Health (NIMH) estimated that 17.3 million adults in the United States had at least one major depressive episode during a typical year. This number represents 7.1% of all adults in the United States.

When left untreated, depression can cause severe health complications that have long-lasting impacts on your physical and emotional health. Although there are well-known methods for treating depression, such as antidepressant medications and therapy, TMS is one of the most effective treatments, especially if patients do not show positive responses to the former treatments.

What Is TMS?

TMS, transcranial magnetic stimulation, is a noninvasive medical procedure that utilizes magnetic fields to generate electric currents in regions of the brain. An electromagnetic coil is strategically positioned against a patient’s scalp near their forehead to target a region of the brain involved with mood.

Once the coil is placed, electromagnetic pulses will painlessly decrease or increase the activity of affected areas of the brain. The TMS procedure doesn’t require anesthesia or analgesia and is typically performed in an outpatient setting. Since the magnetic stimulation is focal and non-systemic, TMS usually has no side effects and doesn’t cause memory loss or seizures like electroconvulsive therapy (ECT).

As mentioned previously, TMS is recommended when patients don’t have sufficient benefit from standard depression treatments. When patients 65 years or older are prescribed to TMS treatments at Mid City TMS, many of them often ask “Does Medicare cover TMS treatments?” and luckily there is Medicare coverage available for TMS in NYC.

Eligibility For Medicare Coverage for TMS

TMS is covered by Medicare if prescribed and administered by a licensed physician like Dr. Bruno at Mid City TMS who accepts Medicare and is knowledgeable in the use of Transcranial Magnetic Stimulation. TMS is indicated for patients with Major Depressive Disorder who have failed to benefit from initial treatment of their depression.

In addition to a diagnosis of Major Depressive Disorder, for TMS treatments to be covered by TMS, a patient has to meet at least ONE of the following criteria:

–a lack of clinically significant response to four antidepressant trials

OR

–an inability to tolerate the side effects of four antidepressants

OR

–a history of good response to TMS in a previous episode.

There are certain circumstances that will limit a patient’s ability to receive Medicare coverage for their TMS treatments, including:

Psychotic symptoms in the current depressive episode.

History of seizures

The following Neurological conditions: epilepsy, cerebrovascular disease, dementia, increased intracranial pressure or a history of repetitive or severe head trauma

Presence of an implanted magnetic-sensitive items located within 30 centimeters from the TMS magnetic coil